Effects of acute angiotensin‐converting enzyme inhibition on diastolic ventricular interaction in the dilated heart

Abstract

SummaryBackground: The normal and dilated heart behaves as a single functional unit during preload reduction; volume unloading in the setting of diastolic ventricular interaction allows for increased left ventricular (LV) filling.Hypothesis: We hypothesized that reduction of venous return induced by a physiologic stimulus (tilting) or by acute angiotensin-converting enzyme (ACE) inhibitors in dilated heart is likely to have a marked and similar effect on ventricular chamber geometry and filling. This study was designed to assess how the normal and dilated heart adapts to preload reduction.Methods: Twenty normal subjects and 20 patients with moderate heart failure due to dilated cardiomyopathy were studied with two-dimensional and Doppler echocardiography in supine position (B) and after 40˚ of head-up tilting (T). The following day, patients repeated supine (C) and tilting test (TC) after administration of captopril (25 mg s.l.). Right ventricular (RV) and LV dimensions, LV geometry, and tricuspid, mitral, and pulmonary venous flow patterns were recorded at each step of the study.Results: In the two groups, T was associated with reduction of RV area and LV volumes; C and TC produced a similar effect on RV and LV. Changes in LV septal-lateral diameter and anterior-posterior diameter were different at each step of the study: during T (both groups) and after C and TC, the septallateral diameter increased slightly while the anterior-posterior diameter decreased. During T, mitral and tricuspid peak flow velocities decreased, peak late velocities were unchanged, and the deceleration time of mitral flow increased; the systolic for-

Association between Grade of Normoalbuminuria and Left Ventricular Diastolic Dysfunction (LVDD) in Hypertensive Population of Gunungsari Village, Pamijahan-Bogor, Indonesia

“…Reduced right ventricular dimension is associated with left ventricular geometry adaptation and reduced left ventricular diastolic pressure, which facilitates left ventricular filling and pulmonary vein drainage. 35 Most of our samples had no antihypertensive therapy (61.3%). From twenty four subjects (38.7%) with antihypertensive therapy, four subjects had ACE inhibitor, one subject had calcium channel blocker and nineteen subjects had not known the name of antihypertensive drug.…”

“…Antihypertensive therapy that altering RAAS such as angiotensin converting enzyme inhibitor (ACE inhibitor) can affect to LVDD event. 35 Reduced preload that induced by ACE inhibitor will affect both ventricular dimension, left ventricular geometry and both ventricular filling. Reduced right ventricular dimension is associated with left ventricular geometry adaptation and reduced left ventricular diastolic pressure, which facilitates left ventricular filling and pulmonary vein drainage.…”